Pregnant and concerned about adequate absorbtion

Hello Everyone! This is my first post, even though I've been reading through the thread for about 2 weeks now trying to absorb everything I can about helping my Thal symptoms. I've know I was Thal Minor since birth, as I was tested immediately since it runs in my family. I've been told, like all of you, that we are asymptomatic and only thing to worry about is having a child with another Thal. I have always experienced extreme fatigue, shortness of breath, heart palpitations, cold extremities, brain fog, migraines, etc.

Here's my question/dilemma:

I am currently 17 weeks pregnant and also a gastric bypass patient. I had the surgery over 6 years ago and haven't been diligent in taking my recommended vitamins. I went through a 3 year period of battling anorexia and then bulimia. During that time I was made aware of how low my Hemoglobin was and had to get a few transfusions to help correct the fatigue and shortness of breath I was experiencing. After leaving treatment for my eating disorders I have be able to maintain my recovery for 1 1/2 years. Now that I am pregnant, I am concerned on how to nourish my body effectively. I am eating well and drinking fresh vegetable juice daily but I am aware that my absorption of nutrients is much less because of the surgery . Up until last week only took a prenatal daily. Since visiting this forum I am taking fish oil, folic acid, prenatal and have ordered wheatgrass powder (which should arrive in a few days).  

I'm worried that I may not be able to have the birth I would like. I am wanting to have a drug-free, doctor-free, intervention-free birth. I am planning on having my birth at a birth center that promotes natural child birth without interventions. But if they find I am in anyway at risk, then I am hospital bound. The thought of this brings me to tears. I have such a strong resentment towards hospitals and doctors, due to past encounters.

That being said, I have an appt. with a hematologist in a week. I'm hoping he can shed some light on how I'm doing since the only blood work I've have in the past year (Aug.) showed my hemoglobin at 10.1.

Can anyone advise me on what I should do next? Anyone else go into a pregnancy deficient in many vitamins?

Thank you all for letting me blab.

Laurie

Hi Laurie,

I would suggest a dose of folic acid between 2-5 mg daily, along with 400 IU vitamin E daily. I would also suggest getting your vitamin D level checked. Anything below a level of 35 needs attention. Your Hb level will be the main determining factor when it comes to interference in the birth. If your Hb level can be maintained above 8 throughout the pregnancy, you should be able to proceed with your plans. The one thing you may want ask to the hematologist is whether your pregnancy should be monitored for thrombosis, as we have had many reports of miscarriages in thal minors and this is most likely due to the same reasons it happens in thal intermedia and major, the hypercoagulable state that often occurs in thals. The vitamin E can help to counter this but it may be prudent to watch for this during the pregnancy. If suspected, the solution is often as simple a taking one daily aspirin.

I'll make sure to have my Vit D levels checked. I'm sure they are low, as I never really get any sun exposure. I'll also ask about being monitored for thrombosis, as my mother has had blood clot problems in the past.

I also wanted to express an extreme appreciation for this website and all of the valuable information that is provided. There is a lot I didn't know and I'm finding that a lot of problems I had or have can be relate to some of the nutrient deficiencies that are talked about frequently.

Thank you for your response Andy.

- L

Update:

I had my appt with my hemotologist yesterday. I'm not sure how I feel about it just yet, but he had me get blood drawn and is having me come back to see him in 2 weeks. What leaves me feeling uncertain was that he wasn't very supportive of my choice to have a natural birth. He thinks he it isn't wise of me to not have a medical doctor present during birth. He also commented that he doesn't think it will be likely that anyone would be willing to assist me in a natural birth since I may need transfusions.

I get that he is trying to inform me on what to expect, but he was so against the thought of a natural birth from the moment I even brought it up. I guess I was hoping for more support, and in turn I ended up feeling worse.

My fingers are crossed for good results...

Do you know what your current Hb level is? This is extremely important.

Test 1 (drawn on 2/6) came back as 9.2 hb <--- from OB/GYN

I had another blood test drawn on 2/13 and I will be getting those results on 2/27. This one is from the hemotologist. I'm sure he will have more insight once his blood test results are in. I'll keep you posted. Thanks.

-L

Hi Laurie,

Your Hb is still above 9 half way through the pregnancy, so that's good for now. Hb will appear lower than it really is during pregnancy because there is an added fluid volume in a pregnant woman that dilutes the blood, making hemoglobin concentration appear a bit lower. The main risk of a thal minor pregnancy is that blood loss during delivery could drop the Hb into an unsafe range. So far, you're doing well. A large study of thal minor pregnancies showed that for most thal minor women, pregnancy and delivery are normal, so thal minor itself should not be considered a risk.

Have you made back-up arrangements at a local hospital, should this become necessary? Is there a birthing room available? This should be done for any home birth or birthing center birth. My wife and I planned home births for all 5 kids but with the first, we did end up in a birthing room at a hospital. It wasn't great but was better than the hospital norm. We made back-up arrangements for every birth and did manage to have 4 at home with a registered nurse-midwife handling the births. It is much nicer outside the hospital setting, but be prepared for anything.

Hi Laurie,

Welcome on board.  I am a mother of 2, alpha thal(similar to HBH).  My last pregnancy was 6 years ago.  I don't remember taking many vitamins at that point of time, only Folic Acid, B Complex and Calcium(because I don't like milk at that point of time).

Keeping your Hb in check is very important because its important for the baby's growth.  My HB wasn't high when I was pregnant.  It would go into a "crisis" of low (7.5-8.5) starting from 2nd trimester onwards.  It was more problematic when I was pregnant with my 2nd child.  I had heart palpitation(120bpm) until the doctor decides for transfusion, and it did solved the problem. 

I believe in hospital birthing because I am no risk taker.  I trust the doctors and nurses would keep both myself and the baby to be in a safe hand.  As much as I would like to be natural as possible, I find it very hard to go all natural(pain free).  I did request for the pain killer at the end because the pain was too much and I was tired.  Having the jab gave me the rest I needed; I think I did doze off a while contributes to me combating drowsiness in between pushing.  Both babies are born naturally(no forceps, no intervention) although I have hb 8.5 at that point of time. 

Just to share about my 2nd child.  It was a tiring job, combating contractions for 2 days(I was hospital bound) before the baby decides to finally came out.  The doctors told me, blood bank on standby.... !!  In  the birthing room, I was put on oxygen(I asked why, the nurse said because I've low HB), coped with the birth but at the end of the birth, I had to be wheeled out instead of a wheelchair because I was too dizzy to sit up. 

I do agree with Andy, you should have a birthing room on standby.  The most important, is to make sure your HB is high enough if you opt for home birth because birthing is a tiring job.  Going on hospital is just to make sure we are close to medical help, when we need it. 

Hey everyone, okay so I saw my Hematologist yesterday and he said I have something called protein s deficiency and that I am definitely iron deficient. I don't know what my hemoglobin was, as the copy he gave me of my blood didn't have it noted on there.

I also got my Vit D level tested... low. My Vit B is on the low end, but still considered normal.

I am being put on a daily injection of blood thinner and getting iron iv therapy starting on Thursday. Is this normal?

Oh I forgot to put the results up...

Iron Total: 37
Iron Binding: 593
Saturation: 6
Ferritin: 5
Vit B12: 225
Vit D: 24
Protein S: 46 <-- low

So how do I deconstruct these results?

Anyone? Any information on what my blood tests results mean? Also anyone familiar with Protein S? My dr. wants me to start a daily injection of blood thinner but I'm very hesistant to start because of the baby.

Protein S deficiency is a disorder of blood clotting. People with this condition have an increased risk of developing abnormal blood clots.. We have countless reports of miscarriage in thal minors and the main reason is the clotting that is a known factor in the more severe types of thalassemia. I suspect it is also quite common among minors and this is why I routinely tell thal minor women to take natural vitamin E, because it is a mild blood thinner and also a powerful antiioxidant. However, if you are taking blood thinning drugs, vitamin E and aspirin should both be avoided, as to not make the blood too thin. Your iron tests do show that you are low, and this is not uncommon in pregnant women. Your D is low and should be corrected. It should be a minimum of 35. A dose of 2000-5000 daily should turn that around. In my case, it takes 5000 IU daily to keep me at a normal level. Your B12 is towards the lower end of normal. It won't hurt to take a daily supplement. B12 is water soluble and is removed from the body quickly, so there is little to no danger of taking too much.

Taking a blood thinning drug can raise the risk of bleeding, so this may affect your planning if it remains necessary to take the drug throughout the pregnancy.

Thanks for your response. I appreciate it. I double checked with my OB/GYN and he has avised me to not take the blood thinners yet. To see if my Protein S drops more. I have been doing the Iron IV's the past 2 weeks and don't really see a difference, but that's ok.

Thanks again

I think you're probably better off using vitamin E than blood thinners. I hope you can continue to avoid using the drugs. I think it would definitely have a negative impact on your chances of using a birthing center.